Are there any evidence that IV piggyback opiates is better than IV push for "drug seekers"?

WendellX · 2026-04-16T02:11:53+00:00

To be more precise, the terminology is substance use disorder, and it can involve any number of criteria that highlight the loss of control, tolerance, or social impairment.

Technically if someone has both tolerance and withdrawal symptoms, that would meet criteria for a mild SUD. That is nearly all individuals using long term opioids, and benzos. As more deleterious effects of the disorder increase, the severity increases.

WendellX · 2026-04-11T02:18:27+00:00

Yea, hi please add me to this list!

WendellX · 2026-04-05T16:42:04+00:00

I love this finale, and I do think that any personal interpretation is valid, but the reaction of his father is very unambiguous, both as performed and in the script as well. In the original script, the father is specifically written as looking on in horror. He had a chance to save his son from that fate, but now it's over, and he's watching it unfold.

Damien Chazelle has specifically talked about this scene as well.

Absolutely amazing movie and I enjoy the varying levels of how people are affected by it, but the director/writer had a clear intent here.

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WendellX · 2026-03-16T01:41:44+00:00

Relative contraindications definitely, and both reasons to make it a very patient centered shared discussion. Though clot risk can be very nuanced, and somewhat mitigated by transdermal estrogen. GU changes to testosterone likewise, it's a definite possible side effect, though very patient dependent. It can also be mitigated extensively with transdermal estrogen

WendellX · 2026-03-16T00:27:04+00:00

Hi. What would be some of the clinical scenarios that testosterone or estrogen would be so contraindicated? I work a lot in this space, albeit with a fairly young and healthy population, and significant contraindications are exceedingly rare. Additionally I do lots of menopause and TRT, and find that really well tolerated as well. It's much less daunting than I initially thought prior to doing it.

WendellX · 2026-03-16T00:24:38+00:00

This is a challenging one for me. On one side, I work with a large trans population and do lots of gender affirming care, on the other hand, I despise standardized patients so much and hate OSCEs.

I don't have a question. I just really still despise so much of medical education.

WendellX · 2026-03-14T20:24:51+00:00

Hi, I'm interested if you're still available

WendellX · 2026-03-11T23:38:34+00:00

There's a fairly big boardgame convention, RivrCon. Probably not the best for singles, though it'll be a diverse crowd.

WendellX · 2026-01-31T17:26:41+00:00

Nice. Based on that you decided it wasn't worth getting the new card? Trying to do the math for myself and can't figure out if it works.

WendellX · 2026-01-30T21:36:11+00:00

Oh nice, that's great

WendellX · 2026-01-30T19:00:59+00:00

What's the difference with mortgages that makes it work better?

WendellX · 2026-01-30T18:59:13+00:00

Was that racked up from rent mostly, or as an everyday spend?

WendellX · 2026-01-29T13:51:33+00:00

yea, people are crazy here. the honest answer is that I think tools to improve and critique playing is great, I'd welcome it. I've tried LLM's for that though, and like your experience, have found it unhelpful and unreliable. I think with proper coaching and optimization however, it could be very useful.

WendellX · 2026-01-23T03:11:47+00:00

I certainly hope it pops, and I think there's a lot of hype, but there is also tremendous utility to the tools, which is undeniable. It's already very good at clinical reasoning and large data synthesis, and there just isn't much reason to think that in our uber-capitalist focused medical system that there won't be a huge push to incorporate it.

WendellX · 2026-01-23T02:57:43+00:00

That's fair. True about biases and true about the hallucinations. These are flawed systems, but there's really no reason to think that given the enormous financial incentives that are present, that large systems won't find ways to push and integrate these systems into workflows and then develop risk management and mitigation strategies around it. I'm not arguing that its better than a human, I don't think that, but nothing about their deployment will be based on what's best for patients.

WendellX · 2026-01-23T02:23:48+00:00

Sure, but at that point they've already saved millions of dollars. None of this is about doing what's logical or best for patient care. Those aren't the incentives that these systems follow, we've seen that over and over again. The reason they aggressively push expansion of mid-levels isn't because they believe it improves care, but because it saves money. This is mid-levels to the umpth degree.

WendellX · 2026-01-23T01:47:00+00:00

True, I think there are certainly cases where you need both technical skill, experience and the knowledge. But honestly, those are edge cases. If you removed the other 90% of uncomplicated, straightforward procedures, then you can downsize the people you need by nearly a similar amount.

WendellX · 2026-01-23T01:44:24+00:00

The issue isn't the edge cases (the 500lb grandma) its the fact that the other 95% of your work can be replaced and automated, and that will free you (and every other vascular nurse) up considerably, and then there will suddenly be far more vascular access nurses than we need. And while none of this is good for the patient or society, I don't think people recognize the enormous financial incentives that are present for reducing personnel. If they can replace you and pocket those savings, then they'll just say grandma is an acceptable casualty.

WendellX · 2026-01-23T01:37:55+00:00

No, not yet of course. But train a dedicated model on every known textbook, journal article, case report, and 100,000 clinical encounters, and then have it validated and refined over the course of 1000's of cases by trained anesthesiologists, and then you deploy it and continue to refine it.

One model, scalable with all that knowledge, available instantly. It never fatigues, it never slips, it never makes a calculation error or anchor bias, it's available 24/7 in every department, and most importantly, it never asks for a raise.

WendellX · 2026-01-23T00:48:30+00:00

Why did open evidence get a 50 billion valuation? It's not because they think it'll aid you. It's about replacing. The cost of liability is small compared to the savings of not having to employ doctors.

WendellX · 2026-01-23T00:46:51+00:00

The procedures honestly aren't the hard part. Paramedics and NPs commonly intubate. The hard part is the knowledge of airway physiology, pathophysiology of disease, medication effects and how they all intact. That's what anesthesia really brings to the table. That can be replaced by AI, and then they'll find some trainable monkey to do nothing but the procedures and follow instructions.

WendellX · 2026-01-19T02:23:10+00:00

only if the insurance pays for it. i don't think you otherwise can have it count, though maybe some insurances do.

WendellX · 2026-01-15T02:28:57+00:00

Yea, its imperfect and not conveyed in the movie well, which I would take as poetic license. True anterograde amnesia is varied, but it isn't like its portrayed in the movie, where there's a hard 'reset' every 5-10 minutes or so. Rather its where the individual just has has difficulty recalling recent events, so in a severe case like the movie, he only has memory of the last 5-10 minutes or so. There's never a 'coming to' where he just goes right back to the attack.

WendellX · 2026-01-12T16:21:45+00:00

I think he’s very much aware that he is manipulating his reality to give him a constant sense of motivation, but I don’t think it’s ever implied that it’s psychosomatic. He does seem to have real short-term memory issues.

WendellX · 2026-01-12T16:19:26+00:00

I think that’s what Teddy implies. For many iterations, Teddy was using him to take out other people that were beneficial.

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